Vascular Surgery

Aim: Indigenous Australians are at high risk of developing diabetes-related foot complications requiring major lower limb amputations. The aim of this study was to assess the incidence and outcome for Indigenous Australians and non-Indigenous Australians undergoing major amputations (MA) at the main tertiary hospital in North Queensland, Australia over a 16-year period. Methods: This was a retrospective study assessing all patients who underwent a MA at The Townsville Hospital between 2000 and 2015. Clinical characteristics were compared using Pearson’s χ2 test and Mann Whitney U test. MA rates (per 100,000) were calculated using the census data as the standard population. Kaplan Meier survival analysis and Cox proportional hazard analysis compared the incidence of all-cause mortality among both groups. Results: A total of 374 MA occurred between 2000 and 2015. Seventy MA occurred in Indigenous Australians and 304 occurred in non-Indigenous Australians. Indigenous patients were younger (p<0.005), more likely to be females (p=0.002), have diabetes (p<0.005), end-stage renal failure (p=0.003), and were more likely to die during follow-up (p=0.028). Overall rates of MA in Indigenous and non-Indigenous patients with diabetes were 291.9 and 70.1 per 100,000 respectively. MA rates increased in Indigenous (~15%) and non-Indigenous patients (~50%) with diabetes between 2000-2007 and 2008-2015 (p=0.505). Indigenous patients were at a ~2-fold greater risk of all-cause mortality (p=0.027) compared to non-Indigenous patients. This association was lost in the multivariate analysis (HR 1.24 [0.82-1.89], p=0.314). Conclusion: The burden of MA has increased in North Queensland and is greater in Indigenous Australians.